Bowen Theory: A View from the 21st Century

Michael E. Kerr, M.D.

After many decades of research, the pathways linking mind and body have been elucidated to the point of overturning Descartes’ notion of mind-body dualism. However, the body and mind as one entity has not yet fully permeated the culture—including the practice of medicine. Conceptualizing mind and body as an interacting whole lends credibility to Bowen theory and its two main variables of degree of anxiety and degree of integration of self. In theory, an anxiety-driven chronic stress response increases the activity of a person’s physiological systems and thus activates a person’s particular vulnerabilities to clinical problems. These commonly activated physiological systems include low-grade chronic inflammation, cell proliferation, fibrosis, white blood cell recruitment, and angiogenesis.

Anxiety disturbs an individual organism’s homeostasis, which triggers the stress response in an effort to restore optimal balance. If a stress response is prolonged, it can result in organ and tissue damage that is associated with disease. Allostasis is a term used when a stress response shuts down coincident with homeostasis being fairly rapidly restored. Allostatic load is a term used when the stress response is protracted or occurring with high frequency during a person’s lifetime, which result in organ and tissue damage.

As the role of disturbances in human relationships gains acceptance as a major contributor to chronic anxiety, Bowen theory’s unique perspective on the specific details of how emotionally significant relationships generate chronic anxiety needs to come to the fore. The theory explains how one family member can disproportionately absorb chronic anxiety generated in a family emotional system. The key variables involved are basic level of differentiation, chronic anxiety, and patterns of emotional functioning that constitute a family stress response. The response can restore family equilibrium, but sometimes at the expense of impairing the emotional functioning of one member. It can also drive a family system into an ever-deepening emotional regression with serious symptom consequences. The impairment can manifest in physical illness, mental illness or a behavioral disorder. Physical and mental symptoms in the impaired family member reflect the internalization of anxiety in contrast to behavioral symptoms that reflect externalization of the anxiety. Consequent to this radically new conceptualization, Bowen theory outlines approaches for reducing chronic anxiety that go beyond conventional stress reduction techniques.

Connecting the family stress response with the stress response of a family member will likely require a systems theory of the individual. The concept of homeostasis applying from the cellular to organism levels has influenced medicine for more than a century. Bowen theory has extended the concept of homeostasis to the family system. Just as a dysfunctional family member is a symptom of a disturbed family relationship system, a systems theory of the individual would view a dysfunctional organ and tissue in the body as a symptom of an anxiety-driven disturbance in overall bodily homeostasis. Although a disturbance in bodily homeostasis in disease is gaining traction in medicine, acceptance is slowed by it being a radical shift away from the current medical model, which views disturbances in the body as a response to a pathological process somewhere in the body. Bowen theory also incorporates factors in the larger culture and other social contexts that influence families.